Affordable Care Act FAQ

Our video here provides detailed information on health insurance buying options. Also, view the graphic below on what you should know about the different types of health insurance products:

Can you still work with eHealth in 2015? Yes, licensed agents are still the only people legally able to advise you regarding health insurance options and benefits when you're trying to choose the right health insurance plan for your specific needs. By law, working with a licensed agent cannot cost you extra. Prices for each available plan have agent commissions built into the cost. So you'll pay the same whether you use a licensed agent or not.

Affordable Care Act navigators are not able to advise you on which plans to purchase. By law, navigators can only assist you in determining whether or not you're eligible for a subsidy, and they can help you through the application process.

Whether or not you can keep your plan or will need to reapply for health insurance in 2014 varies from insurer to insurer. Some of the insurers that are available at eHealth have indicated that they'll transition people in one of three ways:

Inform and Automatically Enroll -- The insurer will make you aware that it's moving you to a metallic benefit plan and will transition you automatically to that new plan with no action required on your part.

Inform and Actively Reenroll -- The insurer will contact you and assist you in actively reenrolling in a new metallic benefit plan.

Only Inform -- The insurer would simply make you aware that your current plan may not qualify you to avoid the tax penalty next year and you have the option to change plans, but the insurer may elect to let you remain on your current plan.

Watch this short video on Obamacare subsidy to see if you qualify.
Also, keep this checklist below handy:
You may qualify for premium tax credits, or subsidies, to help pay for your health insurance if your total Modified Adjusted Gross Income (or MAGI) is between 100% and 400% of the Federal Poverty Level (or FPL) and you meet these requirements:

You live in the U.S.

You are a U.S. citizen, U.S. national, or lawfully present in the U.S.

You are not currently incarcerated.

You are not eligible for other minimum essential coverage.

These subsidies are set on a sliding scale so that what you spend each month is limited to a defined percentage of your income, adjusted to the second least-expensive silver-level plan available in your area. Government subsidies can only be determined by the governing body in your area.

Here is an example for an individual: If you wanted to buy the second least-expensive silver plan available in your area, and your monthly income is 133% of FPL, you would be earning about $1,273 per month in 2013. At that income level, you could spend no more than 3% of your income -- about $38 per month -- to buy that second least-expensive plan. The government subsidy pays the rest of your monthly premium.

As your income increases, so does your share of the cost for the monthly premium. So, if your income rises to 400% of FPL -- about $3,832 per month in 2013 -- you could spend no more than 9.5% of your monthly income -- about $364 -- for that same plan; the second least-expensive silver plan. So if the second least-expensive silver plan available in your area costs $300 a month, and you earn 400% of FPL, there is no subsidy for you.

But if the second least-expensive silver plan available in your area costs $500 a month, the government would pay the difference between the $500 plan and your $364 cap. In that scenario, you would pay $364 per month for your health insurance plan, and the value of your subsidy would be $136 per month; $500 minus your $364 cap.

Now, if there also happened to be a bronze plan available for $400 a month, you could enroll in that plan and get the same $136 per month subsidy. In that case, your plan would cost you $264 per month. Or if you wanted a gold plan that cost $600 per month, you would -- once again -- apply your $136 per month subsidy and pay $464 per month for your insurance policy.

Most individuals will be required to obtain qualified health insurance coverage (or minimum essential coverage which carriers the essential health benefits dictated by the law) or pay a tax penalty to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she may be eligible for an exemption.

The tax penalties start small in 2014 and increase over time. By 2016, those without coverage will pay a tax penalty calculated at the greater of 2.5% of their taxable household income or $695 a year per adult and $347.50 per child (up to a maximum penalty of $2,085 per family). Beginning in 2017, the tax penalties will be increased by the cost-of-living adjustment. Although it is important to note that the tax penalty doesn't apply if you have a gap in coverage of less than three consecutive months in any given year.

It's unlikely that your doctor will know if your health insurance plan is subsidized or not. All the doctor is likely to know is the name of your insurance company.

In most cases, access to doctors will work much like it does today. Health insurance plans contract with networks of doctors, specialists, and hospitals.This network is generally referred to as your plan's "provider network." Some plans have very limited provider networks, and others have very large provider networks. More restricted networks often cost less, and networks with more choices often cost more. This is not likely to change in 2014 or beyond. But plans may be marketed and priced more aggressively based on the size of their provider networks.

So long as you meet eligibility requirements, a lapse in coverage will not prevent you from being able to apply for health insurance during the open enrollment period.

Outside of open enrollment, your ability to apply for health insurance may vary from state to state. And it may be limited to a "qualifying event," such as, but not limited to, the loss of a job, a marriage or divorce, a move, or the birth of a child.

Starting on January 1, 2014, insurance companies will not be able decline your application for health insurance because you have a pre-existing medical condition or for any other health-related reason.

No. There is no requirement in the Affordable Care Act that spouses be on the same plan.
But if you want to qualify for a premium tax credit, or subsidy, to lower the cost of your insurance, be aware that subsidies are based on your total household income level. So even though your spouse will not be covered by the subsidized insurance plan, his or her income will be included when determining the level of subsidy you are eligible for.
View this video on spouse health insurance.

In 2014, all major medical health insurance plans for individuals and small employers will have these new bronze, silver, gold, and platinum benefit levels. And any plan with an effective coverage date after March 23, 2010 in the individual and small group health insurance markets will have to meet one of these four benefit levels. These new bronze, silver, gold, and platinum benefit levels actually refer to a plan's actuarial value level or "AV."

What is actuarial value? The easiest way to explain this is it's the percentage of total average costs for the benefits a plan covers within a given year. So a plan with a 70% actuarial value would typically cover 70% of the costs, and the customer would typically be responsible for 30% of the costs.

The different "AVs" have metallic designations:

A bronze plan is 60%.

A silver plan is 70%.

A gold plan is 80%.

A platinum plan is 90%.

Insurers may also offer catastrophic-only coverage to eligible individuals, and this would have higher cost-sharing than the standard metallic plans. "Metal levels" are designed to let consumers compare plans with similar levels of coverage, based on monthly premiums, provider networks, and other factors with the goal of helping consumers make more informed decisions.

If you have fewer than 50 employees and you offer your employees coverage, they may decline that insurance and seek individual coverage under the Affordable Care Act. Once they make that choice, your administrative duties end. However, whether you offer health insurance or not, it is absolutely critical that you make your employees aware of their obligation to get health coverage under the Affordable Care Act. And you have to let your employees know that they have access to guaranteed coverage in the individual market and that they may be eligible for subsidies.

In most cases, access to doctors will work much like it does today. Health insurance plans will contract with networks of doctors, specialists, and hospitals. As long as your doctor is contracted with your plan, there is no reason to believe that doctor will stop taking appointments.

However, it may take longer to see a physician in person. In some areas, the number of people who have health insurance will increase significantly, but there may not be a corresponding increase in the number of doctors and other medical providers.

To understand more about tax penalty under Affordable Care Act, view our short video here.

You can buy insurance for your kids without insuring yourself, but you and your spouse will be subject to a tax penalty if you do not have qualifying health coverage. When it comes to buying insurance for your kids, effective January 1, 2014, the Affordable Care Act requires any insurer that offers a metallic level plan to an individual adult must also make that plan available to an individual child -- provided the child has not reached his or her 21st birthday at the beginning of the plan year.

The answer is not easy to predict. For some people, costs may go up, at least in the short-term. For others, costs may go down or stay the same. What is critical to understand is that the Affordable Care Act sets a new minimum benefit standard for every major medical health insurance policy in the country. Beginning in January 2014, any major medical plan sold must provide coverage for a minimum of 10 essential health benefits, including:

Ambulatory patient services

Emergency services

Hospitalization

Maternity and newborn care

Mental health and substance abuse

Prescription drugs

Rehabilitative services

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric care

And the law requires that all of these benefits must be covered at a minimum of 60% of their actuarial value.

What is actuarial value? The easiest way to explain it is that it's a percentage of total average costs for covered benefits that a plan will cover. So a plan with 70% actuarial value would typically cover 70% of the costs and the customer would typically be responsible for 30% of the costs.

No, you should be able to determine if you're eligible for a subsidy before you shop for a plan and then have that subsidy applied to any qualified policy you apply for.

Any person who is a U.S. resident and is a U.S. citizen or a U.S. national and is not in jail can apply for a government subsidy and they may qualify as long as they meet, among other requirements, the household income requirements. Under the new law, a person whose household income is between 100% and 400% of the Federal Poverty Level will be eligible for a premium tax credit to reduce the cost of coverage. A person with household income up to 250% of the Federal Poverty Level will be eligible for cost-sharing assistance, as long as they are enrolled in a silver plan.

Yes, but for most people, the process of receiving a rate increase is likely to change. This is how the process typically works today:

Each state is allowed to set its own minimum premium increase that requires a review by regulators

If a rate increases below the state's minimum, there is no review.

The state's minimum is based on its unique premium trends, health care cost trends, and other factors.

This process should not change if you buy your plan on an exchange. Starting in 2014, any plan sold on an exchange will be regulated by the exchange. Whether you buy a plan on or off the exchange, the new process for rate reviews will work like this:

Exchanges will use claims data and other information to evaluate rate increases.

Exchanges will use an analysis of that data to determine if a premium increase is excessive or unjustified.

After 2014, for any plan regulated by the exchange, rate increases will occur once per year in January. All rate increases will be reported, and those that are 10% or higher will be subject to automatic review.

Yes, you can still buy health insurance through eHealthInsurance.com in 2014 and beyond. But in some states, lower-income Americans may not have the same freedom to use eHealthInsurance.com or other web-based brokers as wealthier Americans. That's because some states may require low-income people to apply for insurance that can be purchased with a government subsidy through their state exchange. Federal regulations make it clear that states can allow online brokers to enroll people in subsidized insurance, but some states may elect not to pursue this option.

Understand all about tax penalty under the Affordable Care Act through our shopping tips video.

This infographic below explains in detail how tax penalty works:

If you don't qualify for an exemption to the Affordable Care Act's mandate to purchase qualifying health coverage, then you will be subject to a tax penalty. The tax penalties go into effect in 2014, and if you're uninsured for more than three consecutive months in 2014, you may incur a penalty that would be applied when you file your 2014 income tax return.

The tax penalty is phased-in over a three year period. In 2014, the penalty will be the greater of 1.0% of your taxable income or $95 per adult and $47.50 per child (up to $285 per family). In 2015, the penalty will be the greater of 2.0% of your taxable income or $325 per adult and $162.50 per child (up to $975 per family). In 2016, the penalty will be at the greater of 2.5% of your taxable income or $695 per adult and $347.50 per child (up to $2,085 per family). After 2016, the penalty will be rise annually and be tied to the increase in the cost of living.

Households with incomes below 400% of the Federal Poverty Level will be exempt from paying tax penalties if insurance in their area costs more than 8% of their taxable income, after taking into account employer contributions or tax credits. People can apply for exemptions to the tax penalty if they are fall into one of these categories:

That may vary from state to state and insurer to insurer. Under the new federal guidelines, individuals will have one open enrollment period each year when they can apply for coverage. The first year, exchanges will let people enroll during a six-month open enrollment period that runs from October 1, 2013 to March 31, 2014, for coverage that is effective January 1, 2014 and after.

For coverage starting in 2015, the proposed Open Enrollment Period is November 15, 2014, to February 15, 2015. It's important to note that individual states and individual insurers may also have their own open enrollment periods at different times throughout the year.

This short infographic below shows the three different types of individual major medical health plans:

You current health plan coverage will depend on when your current plan first went into effect -- what is called the "effective date" of your plan.

If your plan has an effective date before March 23, 2010, you may have a "grandfathered" health insurance plan, and you may be able to stay on that plan or change to one of the new metallic plans. But your plan will lose its "grandfathered" status if your insurance company makes significant changes to your plan that reduce its benefits or increase its costs.

If your plan has an effective date between March 24, 2010, and January 1, 2014, it is a "non-grandfathered" plan, and it may have to be converted to a new metallic plan in 2014. Even if your plan's renewal date is later in the year, it may need to be converted to a metallic plan by no later than March 31, 2014, or earlier. But in some instances your insurers may have made the conversion as early as January 1, 2014.

If your plan is purchased with an effective date of coverage that is after January 1, 2014, that plan would need to have one of the metallic benefit levels.

Most likely.
What we've seen indicates that people who lose their jobs will have the option to stay on their employers' health insurance plans for up to 18 months -- which is essentially how COBRA works. What's nice about the Affordable Care Act is that it gives people on COBRA the ability to apply for individual coverage without concern that their application can be declined. And people who opt out of COBRA and buy an individual insurance policy may qualify for low-income subsidies to help them pay for cost of their plan.

The government uses your household's combined Modified Adjusted Gross Income, or MAGI, as a basis to determine your eligibility for a government health insurance subsidy under the Affordable Care Act.

This table below breaks down how subsidy would be applied:

For most people, MAGI is the same as your Adjusted Gross Income (entered on your most recent tax return) and includes: wages, taxable interest and other taxable income, dividends, alimony, and unemployment compensation -- after deductions are made for some self-employed expenses, student loan interest, tuition, and moving expenses, among other things. However, for others, certain amounts may be added to the Adjusted Gross Income to achieve the MAGI, such as certain tax-exempt interest received during the year.

In general, you can estimate your Modified Adjusted Gross Income by finding the Adjusted Gross Income listed on your most recent federal tax return and adjusting it based on any changes (additional income or reductions) you expect to see in your income for this year. A final decision on how much subsidy assistance you may receive is made only by the government exchange authority in your state.

Please note that eHealthInsurance is not a law firm or tax advisor and is not providing legal or tax advice regarding Modified Adjusted Gross Income. Consult with your own legal counsel or tax advisor if you have questions regarding the determination of your MAGI.

Starting on January 1, 2014, insurance companies cannot charge higher rates to people within the same age group based on their gender or health status -- said another way, you can't be charged a higher price for health insurance because you're a woman or because you have a health condition. If you buy your own health insurance, beginning in 2014, your application for coverage cannot be declined because you have a pre-existing condition or for any other health related reason.

Insurers can only price plans based on four factors:

Your age: The oldest person can only be charged three times more than the youngest person for the same plan.

Where you live: The price to deliver care changes from city to city and state to state.

The size of your family.

Your tobacco use: A smoker can be charged up to 50% more for the same plan as a non-smoker.

At eHealthInsurance, we are strongly committed to protecting your privacy. We do not sell, trade or give away your personal information to anyone. We primarily contact our customers by email. We are not affiliated with other agencies that may contact you by phone.